社区首诊制按人头付费方式的探讨——以无锡市为例  

Discussion on the Capitation Based on the Community First Contract Care: Taking Wuxi as an Example

作　　者：徐伟[1] 杜珍珍[1] 

机构地区：[1]中国药科大学国际医药商学院,南京211198

出　　处：《中国初级卫生保健》2016年第3期18-19,共2页Chinese Primary Health Care

摘　　要：在社区首诊制下,配套实施按人头付费,促使首诊社区加强预防保健服务,更大程度上发挥健康守门人作用。人头费跟随参保人自由签约在社区卫生服务机构,首诊机构主动提升医疗服务质量,并严格控制转诊,引导患者合理分流。人头费标准的制定除考虑平均医疗费用、医保基金总量外,还应纳入参保人年龄、性别等因素;针对当前转诊尚无明确标准的现象,建议相关部门制定转诊目录表以规范社区转诊行为;对可能出现的服务量不足问题,应加强监管,以更好发挥社区首诊制作用。Under the community first contract care, the implementation of capitation, prompting first visit communities in strengthen-ing preventive health services, playing a gatekeeper role in health to a greater extent. Capitation fee free following the insured personin the community, first community would take the initiative to improve the quality of medical services, and strictly control the referralof patients to guide reasonable diversion. Setting capitation fee in addition to consider the average medical costs, the total amount ofthe health insurance fund outside, the insured person should also be included age, gender and other factors; there was no clear stan-dard for the current referral phenomenon, it suggested that the relevant departments needed to develop a referral directory table tostandardize community transfer attending behavior; meanwhile, for lacking service capacity issues that may arise, the relevant depart-ments should strengthen supervision in order to achieve better effect with the community first contract care.

关 键 词：社区首诊制 按人头付费 转诊 

分 类 号：R197[医药卫生—卫生事业管理]